CIBOLA COUNTY, N.M. — Cibola General Hospital is a 25 general bed facility with four Intensive Care Unit beds, and doctors at the facility are sounding the alarm.
CGH Chief of Staff Dr. MacFarland Bridges and CGH Chief Hospitalist Dr. Amanda Young, as she was titled by Dr. Bridges, spoke with the Cibola Citizen to warn the public about the COVID-19 wildfire that has engulfed Cibola County.
Just a day after the doctors spoke with the Citizen, Governor Michelle Lujan Grisham issued a Stay-At-Home Public Health Order restricting movement of New Mexicans and closing businesses to help stamp out the COVID-19 influx that has taken the state by storm.
As of November 16, Cibola County has 1,002 cases. A 20.7 percent increase from last Monday. There have been 31 deaths in the county, a 10.7 percent increase. Of the area prisons there are 391 total positive cases when the individual facility numbers are added. People aged 30-39 make up the largest number of infected individuals in Cibola.
Bed and staff availability
“People should not put off their general care for COVID,” Dr. Young said, “I think that needs to be emphasized, because people are putting off their care.”
Despite the COVID-19 pandemic, CGH wants people to continue their basic care.
“People are putting off their care, and then when they do finally come in, they’re more sick,” Dr. Young explained.
CGH is a critical access hospital, so it is limited to 25 beds, however they cannot staff all of their beds. Dr. Young said that staffing is a bigger problem for the hospital than beds.
“It’s a huge concern,” Dr. Bridges said, “Everyone across the state is suffering from staffmg inadequacies — everybody is suffering, every hospital is suffering to get staff. It’s not just in New Mexico, it’s around the country.”
Staffing is particularly important to every hospital, especially nursing staff, the two doctors said. Currently CGH needs mostly nurses and support staff for the nurses because the doctors don’t do the same work that nurses do. One nurse can only have so many patients a day, Dr. Young explained, which is done to keep the patients and the nurse safe and healthy.
New Mexico Health and Human Services Director Dr. David Scrase had said during a COVID-19 press update that 1,000 contract nurses are coming to New Mexico under contract with the state. CGH is unaware if the hospital will be receiving any of these contract nurses.
CGH is still open to public use, and while the hospital battles COVID-19 the facility is still available for residents who need the services it provides.
Is CGH overwhelmed?
“I’d say we’re quite stretched to our limits; we’re pretty maxed out,” Dr. Young explained, “Everyone is spread thin.”
Dr. Young explained that the already short-staffed CGH is doing its best to maintain operations at full capacity, but that the ongoing pandemic makes it difficult as some staff members may become sick.
“The patients come in, and we have an obligation to take care of them. I just did a 10-day stint where we were stretched to the limit every single day,” Dr. Young said.
COVID-19 patients require a lot of additional monitoring, which strains the nursing staff.
When asked why COVID-19 patients require additional monitoring, Dr. Young said, “Because COVID does whatever it wants to all of the body’s functions. [With] the flu, usually you’ll have just a little fever, maybe some body aches and a cough or something, but with COVID, the body goes into an inflammatory response. It’s like all of the soldiers come out at once are just shooting at the body — basically — at once and the body doesn’t have as many soldiers to fight back, especially if you have diabetes, or obesity, because those are already inflammatory states. So If you’re already walking around with an inflammatory state, COVID comes in and it can cause blood clots in the body... so a lot of people are getting blood clots in their lungs or — and we haven’t seen this here some people are having strokes or they’re losing limbs that’s one scary situation we have to watch for which requires constant monitoring.”
“Dr. Young is exactly right, and what probably affects us most — in terms of being able to care for these patients — is the fact that [patients with COVID-19] do not oxygenate their blood well,” Dr. Bridges added, “the purpose of the hemoglobin molecule is to deliver oxygen to the tissues, so when they have this virus they can’t do that very well. So, along with staffing issues then we must have special machines to give people oxygen, and we only have a certain number of those.”
Some patients require ventilators, others require high-flow oxygen, “not two-liters like grandma is on, but 60 liters and there are only certain machines that can deliver that,” Dr. Young said. CGH has around five of these machines, but most COVID patients need the machines.
“Therefore, we can’t oxygenate them, and they can’t live,” Dr. Young added. Dr. Bridges explained that these high-flow machines are not ventilators and that patients typically do much better when they don’t have to be put on the ventilators.
There has been no point where CGH has had to turn away a patient, but Dr. Young said that they have that fear now. CGH does not want to turn anyone away but if the hospital continues to fill up with COVID patients they might have to start turning people away.
There are hub-hospitals for the overflow COVID-19 patients, but anytime they call a hub-hospital to send patients there, they are told that the hub-hospitals are full.
Is COVID-19 really that bad?
“It’s a new type of virus and we’re still learning about what it does I’ve seen the flu. Last year the flu was terrible but with the flu patients don’t get blood clots, they don’t get myocarditis [inflammation of the lung that can reduce the heart’s ability to pump blood, according to the Mayo Clinic] or conditions of the heart,” Dr. Young said, “We have people in their 30s and 40s dying from this, people who are completely healthy.”
“Just imagine, we have a small hospital that usually has sick people already in it,” Dr. Bridges said, “we’re usually taking care of sick people.” Rounding up, Cibola has a population of 30,000, this is a generous estimate, if only one percent of the population caught COVID-19 that would result in 300 sick patients during eight months, according to Dr. Bridges, who explained “that’s going to really tax our system.”
“That’s only COVID-19 patients, not the other critically ill,” added Dr. Young.
A young person may not have symptoms of the disease, but if they are sloppy in following public health orders they run the risk of taking the virus to an elderly family member who may not be able to fight off the infection. The more often this occurs the more the hospital will be filled which will limit the hospital’s ability to do its job.
“We want people to be responsible, to wear a mask, to social distance and to not be stupid by going to a Halloween party or beer bash,” said Dr. Bridges.
Large gatherings
CGH is feeling the effects of Halloween parties right now, and the medical staff is asking people to be smart and safe about what they do.
“If you’re going to Thanksgiving, which is my favorite holiday,” Dr. Bridges said, “We need to not be sloppy.”
The Pueblos of Acoma and Laguna have both been on lockdown and the whole state should be locked down now as well after the New Mexico Governor signed a new public health order to limit the movement of New Mexicans.
The doctors explained that COVID-19 is a highly contagious disease and is more deadly than the average influenza virus, or flu. The virus is unpredictable, Dr. young explained that the flu is predictable; COVID-19 is not.
Schools are a place where children and staff gather in large numbers, Dr. Young said that some of these children are already spreading the disease to their family members.
Dr. Bridges explained that a child could come home from school with COVID-19, give it to their parents or guardians, and then those parents or guardians go to work the next day, creating a massive chain of community spread.
Doctors are not policy makers, both Dr. Young and Dr. Bridges were asked, from a purely public health standpoint, would you close the schools?
“That’s a tough one, if you had asked me a month ago, I would say, ‘absolutely not.’ If you ask me now, I would [have to] say yes. Only because of how bad the virus is,” Dr. Young responded. “It’s so much worse than it was in the spring that I would say yes, temporarily.” Dr. Young explained that people should be allowed to be together, but that it is not safe to do that with COVID-19.
“I think that I don’t know, it’s terrible. You could make a case ‘why don’t we just let this go and we could all get some herd immunity. Unfortunately, weaker patients are going to die but it’ll pass through and we’ll all be better for it.’ Taking care of the ones who are getting it makes it really tough.” Dr. Bridges said.
Advice
Both doctors agree, hand washing, masks wearing, and social distancing can help to limit the spread in the community.
If a citizen must go out, they are advised to do so smartly, wearing a mask, and constantly sanitizing their hands.
Non-essential stores are mandated to close by the governor’s health order. Non-essential activity by citizens is also prohibited to slow the spread of the disease.
Look to next week’s edition of the Cibola Citizen for more on our interview with the CGH team.